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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ2337190 (LAO 0829672) ADJ3193895 (LAO 0829673) ADJ187762 (LAO 0829674)
Regular
Apr 21, 2009

OLIVIA HUERTA vs. GMP LABORATORIES, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, Dr. Elena Konstat, seeking reconsideration of a Workers' Compensation Appeals Board decision that limited reimbursement for her medical-legal reports. The Board found that the original decision erred in disallowing two of Dr. Konstat's three medical-legal reports. The Board clarified that the Official Medical Fee Schedule for treatment rates does not apply to medical-legal expenses, and the testimony of the defendant's lien negotiator was not substantial evidence. Consequently, the Board granted reconsideration, rescinded the original finding, and substituted a new finding allowing reimbursement for all three of Dr. Konstat's medical-legal reports, with the exact amounts, penalties, and interest to be determined.

Medical-legal lienReconsiderationFindings and AwardIndustrial injuryNervous system injuryPsycheLicensed clinical psychologistMedical-legal expensesOfficial Medical Fee Schedule (OMFS)Compromise and Release (C&R)
References
1
Case No. ADJ6484208
Regular
Aug 21, 2018

ERIK LOPEZ vs. SERFIN CONSTRUCTION, INC., STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration and rescinded the prior order, finding that lien claimant South Bay Neurological Diagnostic Center was not entitled to reimbursement for a sleep study. The Board determined the sleep study and associated reports were not valid medical-legal expenses because they were not requested by a medical-legal evaluator and were not incidental to the production of a medical-legal report capable of proving or disproving a disputed medical fact. Therefore, the lien claim was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderAdministrative Law Judgeindustrial injurysleep disorderlien claimantmedical-legal expenseAgreed Medical Evaluator (AME)Report and Recommendation
References
1
Case No. ADJ8094646
Regular
Jan 17, 2014

ALEJANDRINA BARRETO vs. OUT OF THE SHELL, SOUTHERN INSURANCE COMPANY, REPUBLIC INDEMNITY COMPANY, PHARMAFINANCE, LLC, HEALTHCARE FINANCE MANAGEMENT, LLC

This case involves lien claimants PharmaFinance and Healthcare Finance Management, and their representatives Landmark Medical Management and Brian Hall, who sought reconsideration of a decision disallowing their liens for medical treatment. The Appeals Board granted reconsideration solely to notice its intention to impose sanctions of up to $2,500 against the lien claimants and their representatives. This action is due to a pattern of allegedly filing petitions containing false statements about not receiving notices, which violates the Board's Rules of Practice and Procedure and Labor Code Section 5813. The Board found these claims not persuasive and indicative of a tactic to avoid responsibility.

Workers' Compensation Appeals BoardPetition for ReconsiderationSanctionsLien ClaimantsHearing RepresentativesIndustrial InjuryFindings and OrderCompromise and ReleaseNotice of IntentionLabor Code section 5813
References
0
Case No. LAO 0807689
Regular
Mar 24, 2008

CHARLES CASTRO vs. ALPHA THERAPEUTIC CORPORATION, UNITED STATES FIRE INSURANCE COMPANY

This case concerns a lien claimant's award for medical-legal services after the applicant's primary industrial injury claim was settled. The Appeals Board granted reconsideration to allow the defendant credit for any sums already paid to the lien claimant. The Board affirmed the original decision awarding the lien claimant $\$ 3,486.00$ plus penalties and interest for reasonable medical-legal expenses, finding the reports capable of proving a disputed medical fact.

Workers' Compensation Appeals BoardSupplemental Findings and AwardLien TrialIndustrial InjuryCompensable Psychiatric InjuryMedical-Legal ServicesUnreasonable DenialCompromise and ReleaseSubstantial EvidenceQualified Medical Examiner
References
1
Case No. ADJ344700
Regular
Jan 13, 2011

MARTHA GATLIN BANUELOS vs. LIVHOME, INC., as administered by CRUM FORSTER, CENTRAL ORTHOPEDIC MEDICAL GROUP, RONALD KVITNE, M.D. PHYSICIAN PARTNER

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration, finding they were not aggrieved by the decision awarding them full reimbursement for medical services. The defendant's petition for reconsideration was denied as the WCAB adopted the judge's reasoning for upholding the award. The WCAB affirmed the judge's finding that the lien claimant was entitled to $11,508.79 less any penalty or interest, despite an objection to an unsigned bill. This decision resolved disputes regarding the reasonableness of medical charges following an industrial injury.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationDefendant's PetitionAmended Findings and AwardOfficial Medical Fee ScheduleLabor Code section 5900Admissibility of EvidenceExhibit 1Itemized Bill
References
0
Case No. ADJ11204383
Regular
Sep 29, 2025

NASRI BAKRI vs. COSTCO WHOLESALE, HELMSMAN MANAGEMENT SERVICES, LLC

The Workers' Compensation Appeals Board denied NASRI BAKRI's petition for reconsideration regarding a lien claim by Premier Psychological Services. The Board upheld the Workers' Compensation Judge's finding that the applicant's claimed psychological and neurological injuries were non-industrial. Furthermore, Dr. Michaels' medical-legal report, which formed the basis of the lien claim, was deemed not to constitute substantial medical evidence due to insufficient foundation and a lack of comprehensive history. Consequently, Premier's lien claim for both medical-legal and treatment costs was denied in full.

ADJ11204383Costco WholesaleHelmsman Management ServicesLLCPetition for ReconsiderationLabor Code Section 5909Electronic Adjudication Management System (EAMS)Transmission of CaseNotice of TransmissionBurden of Proof
References
14
Case No. ADJ18498378
Regular
Oct 27, 2025

MARIA VENEGAS vs. MARATHON PETROLEUM COMPANY, ACE AMERICAN INSURANCE

Lien claimant, Premier Psychological Services, sought reconsideration of a Findings and Order from July 30, 2025, which denied its lien for medical-legal and medical treatment expenses. The Workers' Compensation Appeals Board (WCAB) granted the petition for reconsideration, rescinded the original F&O, and returned the matter to the trial level for further proceedings. The Board found that the medical-legal expenses were incurred for a contested claim and that the medical report from Dr. Mark Michaels constituted substantial medical evidence for an injury arising out of and in the course of employment, despite some curable deficiencies regarding interpreter information. The WCAB ordered further consideration of the medical treatment expenses and a potential updated utilization review.

Premier Psychological ServicesAdjudication Number ADJ18498378Opinion and Order Granting Petition for ReconsiderationDecision After ReconsiderationLien ClaimantPrimary Treating Physician (PTP)Dr. Mark MichaelsInjury Arising Out of and In the Course of Employment (AOE/COE)PsycheMedical-Legal Report
References
21
Case No. ADJ7348520, ADJ7343936, ADJ7321306
Regular
Oct 25, 2016

Mauricio Arciniega vs. Santa Monica Seafood Company, Compwest Insurance Company

This case involves a lien claimant, Med-Legal Photocopy, seeking payment for subpoenaed medical records. The defendant objected to the lien on grounds of unreasonable necessity, but their objections were untimely and inadequately raised. The Appeals Board rescinded the prior decision disallowing the lien and remanded the case. This will allow the trial judge to determine the amount due to the lien claimant, as the defendant is precluded from objecting to the reasonableness and necessity of the expenses due to their procedural failures. However, the cost of a consultative rating obtained by the lien claimant is not a recoverable medical-legal expense.

Med-Legal PhotocopyReconsiderationDisallowed LienContested ClaimLabor CodeMedical-Legal ExpensesSubpoenaReasonablenessNecessityObjection
References
6
Case No. MISSING
Regular Panel Decision

Legal Aid Society v. Association of Legal Aid Attorneys

The Legal Aid Society sought a preliminary injunction against the Association of Legal Aid Attorneys and its officers to prevent the disciplining of striking union members who crossed picket lines. The plaintiff also claimed tortious interference and a civil rights conspiracy under 42 U.S.C. § 1985(3) on behalf of itself, non-striking attorneys, and indigent clients. The District Court denied the injunction, finding several impediments to success on the merits. These included the NLRB's primary jurisdiction, the Norris-LaGuardia Act's prohibitions, and the plaintiff's lack of standing for third-party claims. Furthermore, the court determined that the conspiracy allegations under Section 1985(3) were conclusory and lacked substantial merit.

Labor DisputePreliminary InjunctionUnion DisciplinePicket LinesNational Labor Relations Act (NLRA)Norris-LaGuardia ActStanding (Law)Conspiracy (Law)Civil Rights (42 U.S.C. § 1985(3))Tortious Interference
References
32
Case No. ADJ9336762
Regular
Mar 17, 2025

Ramiro Hernandez vs. Riverside Landscape & Irrigation Inc., California Insurance Guarantee Association

The Appeals Board considered petitions for reconsideration from lien claimants RMS Medical Group and Basso Pharmacy regarding a WCJ's Findings and Order from December 11, 2024, which denied their lien claims related to applicant Ramiro Hernandez's industrial injury. The Board denied Basso Pharmacy's petition, upholding the finding that Basso Pharmacy was not properly licensed. Conversely, the Board granted RMS Medical Group's petition, ruling that their medical-legal services, performed by the primary treating physician Dr. Gottschalk, are compensable as a medical-legal expense, even with an AME in the case. Consequently, the matter was returned to the trial level for the WCJ to determine the reasonable value of RMS Medical Group's services.

Workers Compensation Appeals BoardRamiro HernandezRiverside Landscape & Irrigation Inc.California Insurance Guarantee AssociationIntercareCastlepoint InsuranceRMS Medical GroupBasso PharmacyPrimary Treating PhysicianMedical-Legal Reports
References
1
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